Raymond Wychowanec often talked about the medical issues that left his wife stooped and unable to stand straight, his neighbors in Gloucester Township said.
Back problems were the culprit, he told them, and surgical procedures had not improved her condition. In the last month and a half, one neighbor said, an ambulance had shown up twice at the couple's Glendora home to take Denise Wychowanec, 62, to the hospital.
On Wednesday, she was at Kennedy Hospital in Stratford, though officials have not disclosed why. Her husband walked in around 9:25 a.m. and made his way to his wife's room on the second floor.
About 45 minutes later, he fatally shot her twice in the chest, authorities said, before shooting himself once in the head as hospital staff walked into the room.
Within several hours - after the pandemonium that unfolded at the hospital, as one patient described it - detectives found Raymond and Denise Wychowanec's son, Ryan, 35, dead in their home on Price Avenue. He had been shot multiple times, authorities said.
Investigators were trying to determine Wednesday whether Raymond Wychowanec, 63, also was responsible for that shooting. He was flown to Cooper University Hospital, where he remained in critical condition Wednesday night.
The shooting at Kennedy was the fourth in five months at hospitals in the Philadelphia area.
The Wychowanecs' neighbors were still trying to fathom what led to the tragedy.
Denise Kehoe, 59, who has lived across from the Wychowanecs for 18 years, described Raymond as a decent man who faced mounting medical bills and was constantly concerned for his wife. Often, Kehoe said, he would tell her when his wife was at the hospital.
"She was always having surgery," Kehoe said. "She just never seemed to get better. It was a shame."
Still, she said, Raymond Wychowanec never appeared angry. He and his wife fed the neighborhood's stray cats and sheltered them in their yard during the winter.
Raymond Wychowanec also told his neighbors how excited he was to buy his wife a laptop for Christmas, they said.
"He never acted like she was a burden," said Laura McCafferty, 36, Kehoe's daughter. "He adored Denise."
Kehoe said Raymond Wychowanec worked at the Sands Hotel Casino in Atlantic City, which closed in 2006. Later, he worked stocking shelves at a Wal-Mart in Deptford, she said.
Investigators were still trying to piece together what happened in the 45 minutes between when Wychowanec walked into Kennedy and when he shot his wife. A law enforcement source said Denise Wychowanec was not in the bed when she was shot but declined to elaborate. She was not terminally ill, the source said.
Gordon Bassing, 51, who was on the same floor waiting to be discharged, described the gunshots as a muffled pop-pop.
Emergency codes then blared on the speakers. Doctors ran in all directions, shutting patients' doors. One nurse, Bassing said, was crying.
"People were just flying all over the place," he said outside the hospital before noon, when the second floor was still restricted to visitors.
It was the first shooting at a Kennedy Health System hospital in 50 years, chief executive officer Joe Devine said.
The hospital is always concerned about patient safety, he said, but does not use wands or search visitors.
"That's not our protocol," he said. "We have to provide access."
Like Kennedy, Our Lady of Lourdes Medical Center in Camden requires visitors to sign in but does not have metal detectors. On Aug. 18 there, a 71-year-old man shot and killed himself after walking into a restroom of the emergency room waiting area.
In July in Delaware County, an armed doctor wounded a troubled patient who had opened fire at a Mercy Fitzgerald Hospital unit, killing caseworker Theresa Hunt, 53.
And in March, a 26-year-old man shot himself in the head after walking into the emergency room lobby of Inspira Medical Center in Woodbury. No one else was injured.
Inquirer staff writer Edward Colimore contributed to this article.